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INTEREST FORM
Interest Form
Step
1
of
4
- Parent/Guardian Contact Information
25%
Parent/Guardian Name
(Required)
First
Middle
Last
Parent/Guardian Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Parent/Guardian Email
(Required)
Parent/Guardian Phone
(Required)
Student Name
(Required)
First
Middle
Last
Student Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Student Email
(Required)
Student Phone
(Required)
Choose a home school:
(Required)
-- Please Select --
Central Elementary
Victory Elementary
Sandycreek Elementary
Franklin Jr. High School
Franklin High School
540 or IEP?
(Required)
Yes
No
Add more children?
First Name
Last Name
Home School
540 or IEP?
Add
Remove
I CAN USE THE COMPUTER AS A TOOL FOR LEARNING...
I can communicate using email
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I can use Microsoft Word as a writing tool
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I can search for and locate information on the internet
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I can participate in online chat rooms
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I POSSESS THE SKILLS NECESSARY TO BE A SUCCESSFUL CYBER STUDENT….
I can follow and respond to written directions easily
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I can use my time efficiently and submit my assignments on schedule
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I am self-motivated, self-directed, and self-disciplined in regards to my studies
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I can work independently
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I AM READY TO MAKE A COMMITMENT TO CYBER EDUCATION
I am willing to spend 5.5 hours per weekday at my computer
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I am willing to spend an additional 1-2 hours per week completing additional assignments
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I am honest and can be trusted to do my own course work and assignments
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I am responsible and will care properly for school-issued equipment
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I am aware that my success as a Cyber student is my responsibility
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I am willing to contact Strong Mind Tech Support when needed
(Required)
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
I have high-speed internet access in my home
(Required)
Yes
No
Consent
(Required)
I agree to the following:
● Complete the Franklin First Learning Academy enrollment and orientation process
● Contact the Franklin First Learning Academy Coordinator for support, as needed
● Notify the Franklin First Learning Academy Coordinator of any change in status
● Actively participate in all courses in which I am enrolled
● Complete all courses in which I am enrolled in their entirety within the specified time allotted.
● Complete all required statewide testing at specified Franklin Area School District building
● Be removed from Franklin First Learning Academy if found to be involved in any form of academic impropriety
● Acknowledge that failure to complete enrolled courses may result in truancy charges
● Return equipment within two weeks of completion of, or withdrawal from, First Learning Academy. Failure to do so may result in being required to pay for equipment
Δ
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INTEREST FORM
